Payment Integrity Systems Specialist II

This is a fully remote position, open to applicants in Florida, +3 more states.

📋 Description

• Perform moderately complex analyses of outputs from the Payment Integrity platform, claims system data, edit/rule behaviors, financial/reporting outputs, and workflow performance.

• Detect exceptions, trends, and operational impacts.

• Oversee incidents, defects, enhancement requests, and intake items using ServiceNow or a similar tool.

• Document requirements, monitor status, coordinate follow-ups, and escalate any blockers.

• Organize UAT, regression testing, validation, and release readiness activities for system modifications.

• Confirm defects and communicate their operational impacts.

• Create and maintain dashboards, trackers, recurring reports, and tools for workstream visibility.

• Assist with platform enhancements, defects, metrics, savings opportunities, and initiatives for operational improvement.

• Collect and analyze data utilizing Excel, SQL, Power BI, financial reporting tools, or other approved reporting platforms.

• Collaborate with Operations, Technology, Finance, governance/delivery, and business stakeholders.

• Specify requirements, document decisions, and support transformation workstreams.

• Enhance data quality, documentation, process consistency, and operational readiness.

• Offer informal guidance or onboarding support to less experienced team members.

• Execute additional duties as assigned and adhere to policies and standards.

⛳️ Requirements

• Bachelor's degree in healthcare, business, finance, accounting, information systems, data analytics, or a related field, or equivalent experience.

• A minimum of 2 years of relevant experience in Payment Integrity systems, managed care claims systems, data analytics, financial reporting, business analysis, platform support, quality assurance, UAT, or a related technical healthcare function.

• Familiarity with managed care claims, Payment Integrity concepts, system workflows, reporting, and operational controls.

• Experience with ticketing systems, UAT/testing documentation, dashboards, workflow tracking, data validation, and cross-functional issue resolution.

• Proficient in Excel and developing proficiency in SQL, Power BI, financial reporting tools, or similar data/reporting platforms.

• Knowledge of Platform Support & Governance.

• Skills in Data Validation & Reporting.

• Experience with Defect & Enhancement Intake.

• Expertise in UAT / Regression Testing.

• Familiarity with Release Readiness.

• Understanding of Financial Systems / Reporting.

• Experience in Dashboard / KPI Development.

• Knowledge in Configuration & Edit Support.

• Familiarity with related Payment Integrity systems and technology support functions.

• Preferred experience with Payment Integrity platforms, claims systems, ServiceNow, Power BI, edit/rule configuration, workflow automation, or platform modernization workstreams.

• Working knowledge of financial systems, accounting principles, and operational financial reporting preferred.

• Credentials or training in Power BI, SQL, business analysis, Lean Six Sigma, healthcare data analytics, project coordination, or coding/claims concepts preferred.

• Preferred credentials include LPN, RN, CPC, CPC-H, CPC-P, CCS, CCS-P, RHIT, RHIA, or CPMA; RHIT, CCS, CIC, CCDS.

🏝️ Benefits

• Competitive pay.

• Health insurance.

• 401K and stock purchase plans.

• Tuition reimbursement.

• Paid time off plus holidays.

• Flexible work arrangements including remote, hybrid, field, or office schedules.

• Additional forms of incentives may be included in total compensation.